Society for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery

Abstract

Optimal evidence-based perioperative blood glucose control in patients undergoing ambulatory surgical procedures remains controversial. Therefore, the Society for Ambulatory Anesthesia has developed a consensus statement on perioperative glycemic management in patients undergoing ambulatory surgery. A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for providing suggestions. It was revealed that there is insufficient evidence to provide strong recommendations for the posed clinical questions. In the absence of high-quality evidence, recommendations were based on general principles of blood glucose control in diabetics, drug pharmacology, and data from inpatient surgical population, as well as clinical experience and judgment. In addition, areas of further research were also identified.

Management of hospitalized type 2 diabetes mellitus patients

“…[48,49] The recommendations and the treatment depend on the type of diabetes, surgical procedure, when patient is going to resume feeding, previous diabetic treatment, glucose control, and metabolic state of patients. [4,50] T2DM patients controlled with diet and exercise, may not need a special preoperative intervention and the glucose can be regulated with correctional regular insulin. Patients with oral antidiabetic or non-insulin injected antidiabetic therapy must discontinue their medications at least 24 hours before surgery and change it for insulin treatment if it is necessary, to achieve normoglycemia.…”

“…In some situations, such as patients with difficult control, intravenous insulin infusion is a good option, although it depends on the accessibility and possibility of patients monitoring. [50,51] Postoperatively, basal bolus regimen is better than sliding-scale insulin to control glucose. If patients do not eat, we must only prescribe basal insulin with a correctional dose of regular or rapid-acting insulin; when patients start to eat, we must administer basal insulin plus nutritional insulin in the meals plus correctional dose.…”

Präoperative Evaluation erwachsener Patienten vor elektiven, nicht Herz-Thorax-chirurgischen Eingriffen

“…Die britischen "National Health Services" (NHS) sowie die "Society of Ambulatory Anaesthesia" (SAMBA) empfehlen sogar die Fortführung der Metformintherapie bei Nierengesunden, u. a. wegen Hinweisen auf ein verbessertes Outcome bei diesem Vorgehen [37]. Bei geplanter intravenöser Gabe von Kontrastmittel sollte allerdings die Metformingabe 24-48 h vor dem Eingriff pausiert werden [38] [41].…”

Preoperative evaluation of adult patients before elective, noncardiothoracic surgery

“…The British National Health Service (NHS) and the Society of Ambulatory Anaesthesia (SAMBA) even recommend continuation of metformin treatment in patients with healthy kidneys, in part because of results indicating a better outcome with this scheme [37]. However, if application of an intravenous contrast agent is planned, metformin treatment should be paused 24-48 h in advance of the procedure [38]. Overall, the decision on whether to continue or discontinue oral antidiabetic drugs should be based primarily on blood glucose management and less on potential adverse effects.…”